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Right Drug, Right Treatment, Right Time – Improving Patient Outcomes in COVID 19

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Three top state government officials from – Tamilnadu, Jharkhand, and Chhattisgarh elucidated on how they bent the curve of COVID-19 pandemic in their respective states and contemplated on a vital topic Right Drug, Right Treatment, Right Time – Improving Patient Outcomes in COVID 19; at the Day 2 opening session of the second edition of the Healthcare Transformation Summit.

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The panelists for the session were J Radhakrishnan, IAS, Principal Secretary, Health and Family Welfare, Government of Tamilnadu, Dr. Nitin Madan Kulkarni, IAS, Principal Secretary, Department of Health, Medical Education and Family Welfare, Government of Jharkhand, and Neeraj Kumar Bansod, IAS, Director, Directorate Health Services, Government of Chhattisgarh.

The others who participated in the panel are AG Prasad, Vice President – Sales & Marketing Institutional sales & Nepal Business, Glenmark Pharmaceuticals Ltd and Dr Ravi Gupta, Founder. CEO, Elets Technomedia Pvt Ltd.

Informing that Chhattisgarh was proactive in combating COVID-19, Neeraj Kumar Bansod, IAS, Director, Directorate Health Services, Government of Chhattisgarh, said, “In the month of May we had only three COVID-19 positive patients in the state of Chhattisgarh particularly in Raipur. During August – September the COVID-19 was on peak in the state as of now the cases are receding in the state. Initially, we had no issue with the availability of beds in COVID 19 dedicated hospitals, but with more positive cases we had to increase the test and brought in protocols to bend the curve. More patients are kept in home isolation.”

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Also read: US likely to start COVID-19 vaccinations by Dec 11: Reports

Detailing about how Tamilnadu has navigated from the status of the worst-affected state of COVID-19, J Radhakrishnan, IAS, Principal Secretary, Health and Family Welfare, Government of Tamilnadu said, “Tamilnadu is one of the states which was definitely one of the worst affected of the pandemic initially. It was the state which had the largest cases reported after Maharashtra, Karnataka, and Andhra Pradesh. Now, the number of COVID-19 positive patients is sliding down. We strictly followed and acted upon what the medical expert team from the World Health Organisation (WHO), central government, and state government informed us. We adhered to each and every step right from screening, disease containment zones, aggressive testing, treating, isolating, and effective contact tracing. “

Informing that the pandemic has taught that there are no short cuts, Radhakrishnan informed that Tamilnadu has strictly adhered to RTPCR based test started with one lab the state has over 200 labs with the capacity of taking about two lakh test on a daily basis.

“Our thumb rule was to increase RTPCR tests 10 times more than what was done in each week in each district. The other game-changing initiative we did was organizing fever camps in the field, which was adjacent to the containment zones. This led to detect more positive cases. In August the cases peaked of about 2.8 lakh cases in September we came down to 1.69 lakh cases and in October after average testing of 70,000 we have come down to 3000 cases,” he said.

Talking about clinical management solutions, Radhakrishnan said, ” Tamilnadu has procured all costly medicines to combat the pandemic be it remedisvir, tocilizumab, and few other drugs. As per the clinicians’, advice one RTPCR test in the screening centre is followed by an x-ray and blood profile. Depending upon the categorization the patients are directed to move to either COVID care centres, hospitals, or be in-home quarantine. Our clinicians believe that plasma is effective, experimentally if it’s given the mild to moderate stage. Also, antibiotic and zinc vitamin is followed by strictly. We are also encouraging Siddha and Ayurveda for immunity booster. Clinicians developed a protocol for each co-morbidities for those who smoke had respiratory issues, diabetic and obese people, which helped in treating the COVID-19 patients. The state had a peak of 127 deaths per day but as of October, the state has less than 40 deaths a day thanks to each and every doctor, nurses, and paramedics who have worked relentlessly. An aggressive supply of pulse oximeter in the field was ensured. The state has 1.42 lakh beds now, 40,000 oxygen beds, adequate ventilators, augmented the oxygen tank capacity till taluk hospitals level.”

Commenting that overall it was a tough learning experience, Radhakrishnan, said, “Tamilnadu has shown a strict reduction in the COVID 19 cases. Everyone need to understand that wearing mask apart from social distancing until we get a vaccine is necessary.”

Sharing the experience of Jharkhand, Dr.Nitin Madan Kulkarni, IAS, Principal Secretary, Department of Health, Medical Education and Family Welfare, Government of Jharkhand, said, “Fortunately the Jharkhand state positive rates have come below two percent. The state got its first testing lab facility on the 14th of March and subsequently, we have installed 24 RTPCR labs. As these labs required a lot of infrastructure facilities, the state switched to TrueNAT testing, which was a quick format of testing. As of now, the state has got 200 plus TrueNAT machines across the state up to the community health center level this has speeded up the testing process. Our total number of deaths has been 900 till now. At the end of August in a single day, 24 deaths were reported, which was the highest but as a whole, compared to other states it was less. We have ramped up all our infrastructure facilities all our district hospitals have ventilators, oxygen supported beds. The major challenge the state faced was to train the medical staff on using the ventilator. We managed it by giving special training on it.”

“As far as clinical management is concerned we followed the ICMR protocols at the same time we take a cautious approach and revised our protocols three times. The mortality rates in government hospitals were very less compared to many private hospitals and the analysis showed that 74 percent of deaths were due to co-morbidities particularly diabetics and kidney-related issues. We had to open separate dialysis units in our medical colleges only for COVID-19 patients. The clinical management teams constantly visited the private hospitals and asked them to follow the same clinical protocols which the government hospitals followed,” Kulkarni said.

Touching upon the other challenges Jharkhand faced, Kulkarni said, “The state saw a huge migrant influx about eight lakh reached the state and about nearly 24,000 were tested positive and increased the caseload but there were no deaths. The migrants were in isolation centers with proper treatment protocols, periodic tests and gave them vitamin, zinc supplements, and ayurvedic supplements to improve the immunity. As for the plasma therapy we had good results though there are many reservations about it we had treated 257 plus cases and all of them had a good recovery.”

He also added that the state has six post-COVID care sectors to address the post-recovery respiratory issues, mental trauma of the patients.

Highlighting about the drugs used for the treatment of COVID-19 and the quality protocol, AG Prasad, said,” WHO declared the COVID-19 as a global pandemic on 11th March 2020 since then there was a series of guidelines were issued by them. Many drugs and immunosuppressant was used, there were many deviations in the SOPs by even the Drug Controller General of India (DGCI) has approved few of the drugs for the clinical trials and also the repurposed drugs like remdesivir, favipiravir were allowed to use for restricted emergency use. When there was no antiviral drug which was available and it was known that COVID-19 was viral infection drugs like hydroxychloroquine HCQ an anti-inflammatory and azithromycin antibiotic was used. Only two repurposed drugs – remdesivir, favipiravir were announced to be safe. Glenmark is the only company that has conducted clinical trials in India on Favipiravir, results were very encouraging. We approached the DGCI they have approved it for emergency usage and the drug is used by 25,000 doctors and it is benefitted over lakh patients. Nearly 25 other pharma companies have come out with the same drug still Glenmark pharmaceuticals has 70 percent of the market share. Even FabiFlu has become the number one brand.”

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